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CMS Clashes With Insurers Over Coding

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The Centers for Medicare and Medicaid Services says it will be adjusting for private Medicare plan operators’ tendency to “upcode” the severity of plan members’ health problems.

Medicare Advantage plan defenders say they plans may simply be attracting sicker members, or coding members’ conditions more accurately than traditional Medicare plans have been.

But CMS officials say they believe at least some of the coding gap between Medicare Advantage plan members and traditional Medicare plan members is the result of conscious upcoding efforts and that they will adjust Medicare plan reimbursement arrangements according.

Senate Finance Committee Chairman Max Baucus, D-Mont., has put out a statement praising the adjustment effort.

“During these tough financial times, we need to make sure that we are not wasting taxpayer dollars by allowing the Medicare Advantage system to run inefficiently,” Baucus says in the statement.


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